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269 pp Price £17.50 ISBN 1-85315-477-6 (h/b)
London: RSM Press, 2000 .
Few medical mortals of the last century can be quite as biograph-able as Almroth Wright (1861-1947), and Michael Dunnill has done his bizarre subject proud.
Born of an Ulster protestant evangelical father and a Swedish mother (Almroth was her maiden name), Wright was brought up in an academic, violently anti-papist household. Equipped with a prodigious memory (he was thought to know a quarter of a million lines of poetry) and overwhelming arrogance, his life was never going to be mundane. At Trinity College Dublin he obtained a first in modern languages while reading medicine, and after a series of research and teaching jobs became head of pathology at Netley, a large RAMC hospital (it no longer exists) on Southampton Water. He was appointed over the head of David Bruce, who had recently described brucellosis; the two became life-long enemies. The rest of the staff did not take to Wright either.
But there was no doubting his skills as a lecturer or his grasp of the published work and at Netley he began his life's work on immunity. By the injection of dead typhoid bacteria he produced immunity to typhoid, first in himself and then in 15 soldiers. Despite the side-effects he pressed on and inoculated 2835 soldiers going to India, where typhoid was common. As far as can be seen, only 5 or 6 of them developed the disease. Unfortunately the records were appallingly kept, and Wright had a deep aversion to statistics. Karl Pearson, the leading biological mathematician of the time, said that the data showed nothing, so Wright had stand-up rows with him. The RAMC sided with Pearson. (Dunnill ascribes Wright's hatred of statistics to his home education, which included no maths.)
But at this point we realize the genius of the man. In private, Wright was a charmer, a brilliant Celtic conversationalist, who was part of the London social scene. He numbered among his friends Richard (later Lord) Haldane, the Secretary of State for War. Wright told Haldane about his typhoid vaccine: Haldane was impressed with its importance, and within a few months, Wright was Sir Almroth Wright FRS. Leishman continued with the typhoid work, and using more rigorous data collection, confirmed Wright's findings.
Meanwhile Wright was appointed Professor of Bacteriology at St Mary's Hospital. He turned the laboratory into a vaccine factory. By 1915 St Mary's had distributed 3 million doses of anti-typhoid vaccine, and it was calculated that between a quarter and half a million soldiers' lives had been saved by its use. Wright broke new ground by financing his vaccine production in collaboration with a drug company (Parke Davis): the department shared the costs and profits with the company. The collaboration lasted about forty years, though most of the later products were vaccines for treating (not preventing) specific diseases, and because of Wright's aversion to statistics there was no evidence that these had any efficacy whatever.
Wright's second major contribution to medicine was characteristically iconoclastic. He objected strongly to the empiricism of clinicians, and during the Great War he tried to prevent the treatment of battle wounds with antiseptic solution, a Listerian tradition blindly followed by military surgeons. With Alexander Fleming he showed that these antiseptics killed the macrophages and neutrophils that were gathering at the wound, and prevented healing; furthermore, the use of antiseptic paste encouraged the growth of anaerobes, with the fatal production of tetanus or gas gangrene. Wright's (successful) approach was to clean the wound with sterile hypertonic saline and suture it secondarily. It took two or three years to overcome the old dogmas, by which time millions more lives had been lost. Would this have been achieved at all without Wright's passion and abrasiveness?
His department was, on the whole, a success, for he maintained the loyalty of such distinguished bacteriologists as Fleming and Colebrook. He sulked when Fleming was given a knighthood, and told two separate individuals (privately) that they would inherit the department when he retired. He believed that there was no place for women in medicine and was a passionate anti-suffragettist. In a debate at St Mary's, Bernard Shaw took the suffragette side and Wright the anti-suffragette; Wright won the debate (but then he was playing at home). As is often quoted, Shaw based the physician in The Doctor's Dilemma (only happy when stimulating the phagocytes) on Wright; the two Celts were good friends, their arguments characterized by neither disputant paying the slightest attention to what the other was saying.
So it was an impossible life—that of a man who believed strongly in the scientific method (and hated contemporary physicians for their empiricism) but was, in the last analysis, a romantic who only accepted those pieces of science that suited him. Dunnill tells us all this impartially and well, but the riddle is never solved. A small point: Wright scowls at us from all the photos in the book (he clearly disliked photographers as he would have disliked lady house-surgeons); and the cover, too, has the old sour-puss glowering out. A shame, really, because it belies the fascination of what is inside.